An Elevated Breathing Reserve Index at the Lactate Threshold Is a Predictor of Mortality in Patients with Cystic Fibrosis Awaiting Lung Transplantation

Tantisira, Kelan G.; Systrom, David M.; Ginns, Leo C.

doi:10.1164/rccm.2105090

Cited by 49 publications

(41 citation statements)

References 45 publications

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“…However, other authors have found no correlation between distance covered in a 12-MWT and survival [202]. Other authors reported that an elevated breathing reserve at hL (defined as V9E at hL divided by the MVV) is associated with an increased risk of death in CF patients awaiting lung transplantation [218]. The utility of this breathing reserve index rests on the fact that it combines a resting measure of lung function with a measure of exercise capacity that does not depend on patients attaining the point of symptom limitation.…”

Section: V9o 2 Peak and Ventilatory Indicesmentioning

confidence: 99%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

European Respiratory Journal

549

390

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Evidence-based recommendations on the clinical use of cardiopulmonary exercise testing (CPET) in lung and heart disease are presented, with reference to the assessment of exercise intolerance, prognostic assessment and the evaluation of therapeutic interventions (e.g. drugs, supplemental oxygen, exercise training). A commonly used grading system for recommendations in evidence-based guidelines was applied, with the grade of recommendation ranging from A, the highest, to D, the lowest.For symptom-limited incremental exercise, CPET indices, such as peak O 2 uptake (V9O 2 ), V9O 2 at lactate threshold, the slope of the ventilation-CO 2 output relationship and the presence of arterial O 2 desaturation, have all been shown to have power in prognostic evaluation. In addition, for assessment of interventions, the tolerable duration of symptom-limited high-intensity constant-load exercise often provides greater sensitivity to discriminate change than the classical incremental test. Field-testing paradigms (e.g. timed and shuttle walking tests) also prove valuable.In turn, these considerations allow the resolution of practical questions that often confront the clinician, such as: 1) ''When should an evaluation of exercise intolerance be sought?''; 2) ''Which particular form of test should be asked for?''; and 3) ''What cluster of variables should be selected when evaluating prognosis for a particular disease or the effect of a particular intervention?''

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Section: V9o 2 Peak and Ventilatory Indicesmentioning

confidence: 99%

Recommendations on the use of exercise testing in clinical practice

Palange¹,

Ward²,

Carlsen³

et al. 2006

European Respiratory Journal

549

390

View full text Add to dashboard Cite

show abstract

“…More recently, Tantisira et al [142] evaluated an index that combines the resting lung function (MVV) and ventilation at AT (an independent parameter of a patient’s ability to perform at maximal effort). They found that CF patients with a higher breathing reserve at AT (defined as V′ E at AT/MVV) had an increased mortality rate.…”

Section: Exercise Intolerance In Cystic Fibrosismentioning

confidence: 99%

Cardiopulmonary Exercise Testing in the Functional and Prognostic Evaluation of Patients with Pulmonary Diseases

et al. 2009

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Exercise testing is increasingly utilized to evaluate the level of exercise intolerance in patients with lung and heart diseases. Cardiopulmonary exercise testing (CPET) is considered the gold standard to study a patient’s level of exercise limitation and its causes. The 2 CPET protocols most frequently used in the clinical setting are the maximal incremental and the constant work rate tests. The aim of this review is to focus on the main respiratory diseases for which exercise tolerance is indicated; for example, chronic obstructive pulmonary disease, interstitial lung disease, primary pulmonary hypertension and cystic fibrosis. This review also focuses on the variables/indices that are utilized in the functional and prognostic evaluation. The recognition of abnormal response patterns of ventilatory, cardiac and metabolic limitation to exercise may help in the diagnostic evaluation. In addition, CPET indexes can provide important functional and prognostic information regarding patients with pulmonary disease. Exercise indices, such as peak oxygen uptake (V’O_{2 peak}), ventilatory equivalents for carbon dioxide production (V’_E-/V’CO₂) and arterial oxygen saturation (S_pO₂), have in fact proven to be better predictors of prognosis than lung function measurements obtained at rest. Moreover, useful information on the effects of therapeutic interventions may be obtained by CPET by studying the changes in endurance capacity during high-intensity constant work rate protocols.

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“…Often, a patient's aerobic exercise capacity is also determined to make training recommendations or to determine the effects of a conditioning program [3,4,5,6]. Furthermore, exercise capacity provides prognostic information for clinical outcome and with respect to mortality [7,8,9,10,11,12,13] and may be useful for the assessment of lung transplant candidates [14,15], even though the evidence for an additional value in this respect is currently limited. Finally, exercise capacity is related to quality of life [16].…”

Section: Introductionmentioning

confidence: 99%

Statement on Exercise Testing in Cystic Fibrosis

Hebestreit

Arets²,

Aurora³

et al. 2015

Respiration

137

227

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This statement summarizes the information available on specific exercise test protocols and outcome parameters used in patients with cystic fibrosis (CF) and provides expert consensus recommendations for protocol and performance of exercise tests and basic interpretation of results for clinicians. The conclusions were reached employing consensus meetings and a wide-band Delphi process. Although data on utility are currently limited, standardized exercise testing provides detailed information on physiological health, allows screening for exercise-related adverse reactions and enables exercise counselling. The Godfrey Cycle Ergometer Protocol with monitoring of oxygen saturation and ventilatory gas exchange is recommended for exercise testing in people 10 years and older. Cycle ergometry only with pulse oximetry using the Godfrey protocol or treadmill exercise with pulse oximetry - preferably with measurement of gas exchange - are second best options. Peak oxygen uptake, if assessed, and maximal work rate should be reported as the primary measure of exercise capacity. The final statement was reviewed by the European Cystic Fibrosis society and revised based on the comments received. The document was endorsed by the European Respiratory Society.

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An Elevated Breathing Reserve Index at the Lactate Threshold Is a Predictor of Mortality in Patients with Cystic Fibrosis Awaiting Lung Transplantation

Cited by 49 publications

References 45 publications

Recommendations on the use of exercise testing in clinical practice

Recommendations on the use of exercise testing in clinical practice

Cardiopulmonary Exercise Testing in the Functional and Prognostic Evaluation of Patients with Pulmonary Diseases

Statement on Exercise Testing in Cystic Fibrosis

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